Why I Want to Hear From Your Mom

Jim comes into the clinic waiting room and plops down with his mom seated next to him. She nervously clutches her handbag, a look of worry evident in her eyes. When I call him into the interview room, his mother’s eyes dart from me to him and back. Does she have something she wants to tell me?

“Why don’t you come back with him, just for a few moments,” I say to the mom. Jim huffs at her. I smile cautiously at him and wait for his mom to follow.

Inside the room, door closed, I ask Jim if it was his idea to come for the evaluation, or someone else’s. He tilts his head toward his mother and rolls his eyes. He says, “I’ve been a little bit anxious with school and everything, that’s all. I’m fine. I went to a holistic herbal shop and got some new supplements. I don’t need to be here. She’s just hysterical, as usual.

I turn to address Jim’s mom. “Can you tell me why you wanted him to come for the evaluation?”

She glances over at Jim from the corner of her eye to see him lean back in his chair and look up at the ceiling. “Jim hasn’t slept in several days. We hear him upstairs during the night, in and out of closets and boxes. I don’t know what he is doing up there, but he seems agitated at night and moody all day. He peels out of the driveway recklessly when he leaves the house. Jim has always been calm, quiet, and easy going. He has always slept 10-12 hours a night. He has never been like this before.”

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People seek psychiatric evaluation for any number of reasons: anxiety, depression, inability to sleep, changes in behavior, substance use. They sit down in a chair, answering questions about their inner experiences and trying to explain a hidden problem. They offer a peek inside their minds and hearts.

But I always want to hear from their families, too.

In healthcare, we refer to the information obtained from significant others “collateral reports.” I want to hear as many collateral reporters as I can find. Not all healthcare professionals agree with this view. They worry that involving family members can bias the clinical picture, or that somehow privacy will be breached by asking questions of the wrong family member. Still, I am adamant about the value of an outsider point of view to make things clearer.

Maybe you are a healthcare professional, or maybe a patient reading these words, and perhaps the idea that family should be directly involved in your healthcare evaluations seems to cross the line. If so, hear me out.

Psychiatry is the medical discipline that treats mental health problems, or lately referred to as “behavioral health” problems. “Mental” and “behavioral” health are the purview of my field of medicine. “Mental” = internal, thoughts and feelings hidden out of view, on the inside. “Behavioral” = external action, on display for others to view.

· Only the patient himself can tell me his mental state.

· And I can rarely rely on a patient himself to accurately describe his own behavior problems.

The patient describes his first person perspective on how he feels and thinks. Families give information about what happens on the outside, the changes in behavior visible from their perspectives.

In mental health, we have to hear from Jim’s mom. Otherwise, we will be operating with bad information, treating the wrong problem.